Bone Abstracts

There is the question, if routine screening of hypercalcemia and hypovitaminosis D in the whole Czech population may be considered meaningful and economical.

Primary hyperparathyroidism is a frequent cause of hypercalcemia. At our clinic we surgically treat 180 patients diagnosed for primary hyperparathyroidism on average per year. In the sample we detect 24% rate of ectopic gland localization. Such ectopic localization complicates effective surgery, stretches out the operating and anaesthesia time and increases the rate of surgery failure if not diagnosed properly before the operation. Besides the obvious US visualisation we routinely perform MIBI-SPECT/CT, which we consider the most effective method. SPECT /CT has 87–93% sensitivity and 90% specificity in detection of hyperparathyroid tissue. Selected case studies will be presented to depict the typical ectopic localizations, the benefits and downsides of the respective localization methods will be demonstrated and the resulting surgical strategies will be discussed. The 3D SPECT/CT image allows the decision between mini-invasive approach, uni-lateral neck exploration or the necessity of sternotomy, which happens in 5% of the time. Overall surgery success rate of 98.5% (significant drop in intact serum PTH and Ca) is achieved thanks to careful pre-operational localization. Such rate should be considered excellent enough to justify routine screening of hypercalcemia and hypovitaminosis D in the whole Czech population.